Active NPI
Kenneth R Brewer, DPM
- Foot & Ankle Surgery Podiatrist
- Tacoma, WA
National Provider Identifier
1760415657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Foot & Ankle Surgery Podiatrist
- License
- PO00000585
- Practice address
- 1708 Yakima Ave
Ste 110
Tacoma, WA 98405-5307 - Phone
- (253) 627-9151
- NPI assigned
- Jul 7, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Foot & Ankle Surgery Podiatrist | 213ES0103X | PO00000585 | WA | Primary |
Addresses
Primary practice location
1708 Yakima Ave
Ste 110
Tacoma, WA 98405-5307
Mailing address
1708 Yakima Ave
Ste 110
Tacoma, WA 98405-5307
Phone (253) 627-9151
Other identifiers 8
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 480033767 | Other | WA | MEDICARE RAILROAD |
| 480033768 | Other | WA | MEDICARE RAILROAD |
| 8936260 | Other | WA | STATE CRIME VICTIMS |
| 8936261 | Other | WA | STATE CRIME VICTIMS |
| 0226419 | Other | WA | STATE L&I |
| 158900 | Other | WA | STATE L&I |
| 0158901 | Other | WA | STATE L&I |
| 8311193 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PO00000585 | WA | MD | Foot & Ankle Surgery Podiatrist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1152230400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1289865600000",
"number": "1760415657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1708 YAKIMA AVE",
"address_2": "STE 110",
"city": "TACOMA",
"state": "WA",
"postal_code": "984055307",
"telephone_number": "253-627-9151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1708 YAKIMA AVE",
"address_2": "STE 110",
"city": "TACOMA",
"state": "WA",
"postal_code": "984055307",
"telephone_number": "253-627-9151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BREWER",
"first_name": "KENNETH",
"middle_name": "R",
"credential": "DPM",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-07-07",
"last_updated": "2010-11-16",
"status": "A"
},
"taxonomies": [
{
"code": "213ES0103X",
"taxonomy_group": "",
"desc": "Podiatrist, Foot & Ankle Surgery",
"state": "WA",
"license": "PO00000585",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "480033767",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDICARE RAILROAD",
"identifier": "480033768",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8936260",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE CRIME VICTIMS",
"identifier": "8936261",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0226419",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "158900",
"state": "WA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "STATE L&I",
"identifier": "0158901",
"state": "WA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8311193",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Tacoma, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 16, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.